OB/Peds Chapter 31: Various
Babinski reflex is present in the child throughout the first _____________ of life.
12 months
A 4-month-old infant is brought to the clinic by his parents for a well-baby checkup. What should the nurse include at this time concerning injury prevention? "Never shake baby powder directly on your infant because it can be aspirated into his lungs." "Do not permit your child to chew paint from window ledges because he might absorb too much lead." "When your baby learns to roll over, you must supervise him whenever he is on a surface from which he might fall." "Keep doors of appliances closed at all times."
"When your baby learns to roll over, you must supervise him whenever he is on a surface from which he might fall." Rolling over from abdomen to back occurs between 4 and 7 months. This is the appropriate anticipatory guidance for this age. Not shaking baby powder directly onto the infant is appropriate guidance for a first-month appointment. Not permitting the child to chew paint from window ledges should be included at the 9-month visit when the infant is beginning to crawl and pull to a stand. Keeping doors of appliances closed at all times should be included at the 9-month visit when the infant is beginning to crawl and pull to a stand.
Which infants are at an increased risk for SIDS?
- Low birth weight - Low APGAR score - Recent viral illness - Siblings of two or more SIDS victims - Male sex - Native American or African American
What are some factors that may reduce the risk for SIDS?
- no smoking during pregnancy or near the infant - supine sleeping position - no soft, moldable mattresses - no blankets or pillows - no bed sharing - breastfeeding - no overheating during sleep
At what age should the nurse advise parents to expect their infant to be able to say "mama" and "dada" with meaning? 6 months 8 months 10 months 12 months
10 months
Colic generally resolves around ________________ of age.
12 to 16 weeks
Which normal findings (age and developmentally appropriate) does the nurse find during the assessment of a 5-month-old child? . Babinski reflex Tonic neck reflex Startle reflex Tooth eruption Doubling of birth weight
Babinski reflex Tooth eruption Doubling of birth weight
Which normal finding does the nurse expect to find when assessing an 8-month-old infant? Doubled birth length Eruption of the upper lateral incisors Eruption of the lower central incisors Equal head and chest circumference
Eruption of the lower central incisors
An 8-month-old infant is able to pick up pieces of food. The parent is impressed with this skill and tells the nurse about it. What does the nurse tell to the infant's parent about this behavior? It indicates that the infant is hyperactive. It is palmar grasp, which is expected at this age. It is pincer grasp, which is expected at this age. It is an abnormal finding that requires evaluation.
It is pincer grasp, which is expected at this age. From 8 months onwards, the pincer grasp is developed. It is a normal finding in an 8-month-old child. This activity does not indicate that the child is hyperactive. The activity does not indicate palmer grasp. In a 1-month-old child palmar grasp is observed. It begins to fade at 2 months and disappears by 4 months. It is not an abnormal finding and further evaluation is not required. p. 867
The nurse is assessing a 9-month-old infant. Which type of play should the nurse suggest to the infant's parents? (Select all that apply.) Pat-a-cake Peekaboo Push-pull toy Soft stuffed toy Large plastic ball
Pat-a-cake Peekaboo
The nurse is assessing a 5-month-old infant. Which behavior does the nurse observe in the infant? Grasping the feet and pulling them toward mouth Picking up a toy and putting it into the mouth Transferring toys from one hand to the other Taking out objects hidden under a pillow
Picking up a toy and putting it into the mouth
What dietary change can mom make for a breastfeeding baby with colic?
She can try eliminating cow's milk protein from her diet. This includes some nondairy creamers.
T/F: Because of their benefit as a source of iron, infant cereals should be continued until the child is 18 months of age.
True
How long can breast milk be stored in the refrigerator?
Up to 5 days
How long can breast milk be stored in the freezer?
Up to 6 months
The first primary teeth to erupt are the ______________, which appear at approximately ________________ months of age.
lower central incisors 6-10 months of age (average 8 months)
Infants should sleep in the _______ position from birth to 6 months.
supine
The nurse is educating parents about sudden infant death syndrome (SIDS). What instructions should the nurse give to the parents for preventing SIDS? (Select all.) "Soft bedding should be used for the infant's bed." "The side-lying position is the best for the infant." "Adults should not share their bed with the infant." "Smoking should be prohibited around the infant." "Preterm infants can be placed in the supine position."
"Adults should not share their bed with the infant." "Smoking should be prohibited around the infant." "Preterm infants can be placed in the supine position." SIDS is defined as the sudden death of an infant younger than 1 year that remains unexplained after a complete postmortem examination. The nurse should educate the parents to avoid bed-sharing with infant because it increases the chances of overlaying and results in infant death. Smoking should never be allowed around infants. Smoking increases nicotine concentrations in lung tissue of the infant and may result in the sudden death of the infant. Preterm infants can be placed in the supine position to prevent suffocation. Soft bedding can cause suffocation because infants cannot yet move their heads to the side. A side-lying position is not suitable for the infant because it also increases the chances of suffocation. p.912
The nursing student who is posted in the pediatric unit asks the nurse, "Which behaviors would be expected in 8-month-old infants?" Which appropriate answers does the nurse state to the nursing student? The child: (Select all that apply.) "Can play peek-a-boo." "Can drink from a cup." "Exhibits stranger anxiety." "Can remove some clothing." "Can stand by holding furniture."
"Can play peek-a-boo." "Exhibits stranger anxiety." "Can stand by holding furniture." At this age the infant can play peek-a-boo. It is a typical behavior of an 8-month-old infant. The infant can easily understand that the person is still there even when the person is out of sight. An 8-month-old infant exhibits stranger anxiety. Stranger anxiety shows a good relationship between infant and parent. At this age the infant can stand by holding furniture. An 8-month-old infant is not able to drink from a cup or remove clothes. These activities require more muscle coordination, which will not be achieved by the infant at this age. A 12-month-old infant is able to drink from a cup. An 18-month-old infant is able to remove clothes. pp. 867, 869, 876
The nurse has prepared feeding guidelines for an infant with failure to thrive (FTT). The nurse instructs the student nurse to feed the infant. Which guidelines should the nurse explain to the student nurse before feeding? (Select all that apply.) "Continue to talk to the infant while providing the feeding." "Do not stand face-to-face with the infant during feeding." "Introduce new food on a regular basis in the infant's diet." "Provide a quiet, unstimulating atmosphere to the infant." "Maintain a calm, even temperament throughout the meal."
"Continue to talk to the infant while providing the feeding." "Provide a quiet, unstimulating atmosphere to the infant." "Maintain a calm, even temperament throughout the meal." The nurse should instruct the student nurse that an infant with FTT is very distractible, so the nurse should be able to refocus the infant's attention on feeding. The student nurse should give positive reinforcement to the infant during the feeding. Therefore the nurse should talk to the infant throughout the feeding. The nurse should provide a quiet, unstimulating atmosphere to the infant because the infant with failure to thrive (FTT) is very distractible and his or her attention is diverted with minimal stimuli. The nurse should a maintain calm, even temperament throughout the meal because negative outbursts may be common in this infant. The student nurse should maintain face-to-face contact with the infant while eating. This provides a positive environment that the infant can start related to feeding time. New foods need to introduced slowly because infants with FTT are often exclusively bottle-fed and may be reluctant about other types of food. p.910
Which characteristic of fine motor skills does the nurse expect to find in a 5-month-old infant? Strong grasp reflex Neat pincer grasp Able to build a tower of two cubes Able to grasp object voluntarily
Able to grasp object voluntarily The ability to grasp an object voluntarily is appropriate for a 5-month-old infant. A strong grasp reflex is characteristic of a 1-month-old infant. A neat pincer grasp is characteristic of an 11-month-old infant. The ability to build a tower of two cubes is characteristic of a 15-month-old infant. p. 866
Which developmental changes are observed in a 5-month-old infant? (Select all.) Birth weight has doubled. The rooting reflex is present. There are signs of tooth eruption. Length has increased by 50% from length at birth. Head and chest circumference are equal.
Birth weight has doubled. There are signs of tooth eruption. In a 5-month-old infant, the birth weight is doubled and signs of tooth eruption are observed. These are normal findings according to growth and development. The rooting reflex disappears at 4 months and may not be observed in a 5-month-old infant. In a 12-month-old infant, the birth length is increased by 50% and the infant has equal head and chest circumference. p.866
The nurse is assessing a 4-month-old infant. Which reflex should the nurse expect to find in the infant? Rooting Crawling Drooling Tonic neck
Drooling Drooling begins around the age of 4 months. The nurse may observe drooling in a 4-month-old infant because they have a poorly coordinated swallowing reflex. In a 4-month-old infant, rooting, crawling, and tonic neck reflexes are not observed because these reflexes disappear at this age. The crawling reflex disappears by the age of 2 months. p.866, 870
Which activity does the nurse expect to observe in a 4-month-old infant? The infant: Grasps an object by using both hands. Grabs an object by pulling on a string. Transfers objects between both hands. Matches two cubes and brings them together.
Grasps an object by using both hands. A 4-month-old infant has the ability to grasp objects with both hands. A 4-month-old infant is unable to secure an object by pulling on a string due to lack of fine motor skills. The infant is unable to transfer objects from one hand to the other or compare two cubes by bringing them together due to lack of developmental skills. At this age, the infant's muscle coordination is not well developed for performing these activities. An 8-month-old infant is able to secure an object by pulling on a string. A 7-month-old infant is able to transfer objects from one hand to the other. A 9-month-old infant is able to compare two cubes by bringing them together. p.866
The nurse is providing education to a parent of a 10-month-old infant receiving iron supplements. What will be included in the teaching? (Select all that apply.) Administer iron with meals. Place iron toward the back side of the mouth with a dropper. Mix iron with milk for greater absorption. Report black, tarry stools to health care provider. Caution parents not to switch to a low-iron-containing formula or milk.
Place iron toward the back side of the mouth with a dropper. Caution parents not to switch to a low-iron-containing formula or milk. Administration of iron supplements includes the following: (1) Ideally iron supplements should be administered between meals for greater absorption; (2) Liquid iron supplements may stain the teeth, therefore administer with a dropper toward the back of the mouth (side). In older children, administer liquid iron supplements through a straw or rinse mouth thoroughly after ingestion; (3) Avoid administration of liquid iron supplements with whole cow's milk or milk products, as these bind free iron and prevent absorption; (4) Educate parents that iron supplements will turn stools black or tarry green; (5) Iron supplements may cause transient constipation. Caution parents not to switch to a low-iron containing formula or whole milk, which are poor sources of iron and may lead to iron deficiency anemia (see Iron Deficiency Anemia, Chapter 43); (6) In older children, follow liquid iron supplement with a citrus fruit or juice drink (no more than 3 to 4 oz); (7) Avoid administration of iron supplements with food or drinks that bind iron and prevent absorption. p. 882
What is the quick method for determining the average number of deciduous teeth for children under 2 years of age?
age of the child in months - 6 = number of teeth Example: 8 months of age - 6 = 2 teeth at this time
The primary goals in the nutritional management of children with failure to thrive (FTT) are: (Select all that apply.) allow for catch-up growth. correct nutritional deficiencies. achieve ideal weight for height. restore optimum body composition. educate the parents or primary caregivers on child's nutritional requirements. educate the parents or primary caregivers that the child will need tube feedings first.
allow for catch-up growth. correct nutritional deficiencies. achieve ideal weight for height. restore optimum body composition. educate the parents or primary caregivers on child's nutritional requirements. The goal is to provide sufficient calories to support "catch-up" growth, which is a rate of growth greater than the expected rate for age. Correction of nutritional deficiencies is another goal that may require multivitamin supplements and dietary supplements with high-calorie foods and drinks in addition to treating any coexisting medical problems. Accurate assessment of the child's initial weight and height is important, as well as the daily recording of weight, food intake, and feeding behavior. Correction of nutritional deficiencies is another goal that may require multivitamin supplements and dietary supplements with high-calorie foods and drinks in addition to treating coexisting medical problems to optimize body composition. A goal is to provide education to the parents or primary caregiver of the child's nutritional requirements along with appropriate feeding methods. p.909
The exhausted parents of a 2-month-old infant with colic ask the nurse what is the best method to promote comfort and sleep for the infant. The nurse's initial action is to: advise the mother to follow a milk-free diet for 3 to 5 days. take a thorough, detailed history of usual daily events. administer simethicone drops to provide relief from gas pains. explain that the parents need to stay calm so the infant will remain calm.
take a thorough, detailed history of usual daily events. The initial step in managing colic is to take a thorough, detailed history of the usual daily events including: diet, time of day when child cries, presence of family members, type of cry, etc. Before suggesting formula changes or medications to relieve symptoms, a detailed history is needed. It is important that the nurse convey an empathetic and compassionate attitude and reassure the parents that they are not doing anything wrong.
